Wullstein C, Köppen M, Gross E
1. Chirurgische Abteilung, Allgemeines Krankenhaus Barmbek, akademisches Lehrkrankenhaus der Universität Hamburg, Rübenkamp 148, 22291 Hamburg, Germany.
Surg Endosc. 1999 May;13(5):484-7. doi: 10.1007/s004649901018.
Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced laparoscopic techniques to deal with iatrogenic colonic perforations.
Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection, or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded.
Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients (one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures. There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically treated patients were satisfied with their clinical outcome and cosmetic results.
Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to colonoscopy.
结肠镜检查相关的结肠穿孔虽罕见但属于严重并发症。保守治疗的侵入性低于大型手术，但一旦治疗失败，后续手术范围会更广，发病率和死亡率也高于直接进行手术修复。为降低大型手术的侵入性并避免失败风险，我们引入了腹腔镜技术来处理医源性结肠穿孔。
通过诊断性腹腔镜检查确定每例结肠穿孔情况。然后根据热损伤的大小和范围将穿孔分为三种类型之一，再进行针对性治疗（缝合、切线切除、节段性切除或开放手术）。记录手术时间、并发症、临床结果及患者满意度。
7例患者因结肠穿孔接受了诊断性腹腔镜检查。5例患者接受了腹腔镜治疗（1例单纯缝合关闭，3例切线切除，1例节段性切除）。2例需要进行开放手术。有1例术中并发症需要中转开腹。无术后并发症。所有接受腹腔镜治疗的患者对其临床结果和美容效果均满意。
腹腔镜治疗似乎可降低大型手术的侵入性和发病率。同时，它比保守治疗更具确定性，因此我们现在更倾向于使用腹腔镜技术治疗与结肠镜检查相关的结肠穿孔。
